Boston type I keratoprosthesis

Successful corneal solid tissue transplantation, beginning with penetrating keratoplasty (PKP), and evolving to include contemporary lamellar and endothelial keratoplasty, has been a tremendous advancement in the struggle to combat corneal blindness. However, there remain patients with high-risk features predictive of transplant failure, for whom donor keratoplasty is not a viable option. Prosthetic corneas have therefore been developed in order to meet the needs of these patients. The Boston type I keratoprosthesis (BKPro) is the most widely used prosthetic cornea in the treatment of corneal blindness. In the years since the BKPro's introduction, refinement of surgical technique and clinical management as well as improvements in prosthetic design have contributed to promising patient outcomes, particularly in the short term. As such, patients with keratoprosthesis implants continue to grow in number, and the indications for the BKPro have commensurately increased. However, risks of permanently blinding complications after implantation persist over all stages of follow-up. For the foreseeable future, the success of keratoprosthesis (KPro) implantation will continue to depend on refined patient selection, preoperative optimization, and incisive postoperative management. Here we explore indications, surgical technique and postoperative outcomes as well as several core tenants in the management of BKPro patients: limiting glaucomatous progression, controlling inflammation, and optimizing the ocular surface. The exquisite sensitivity of the BKPro-implanted eye to perturbations in any one of these areas showcases the intimate relationship between the prosthetic device and its surrounding environment.